PIP medical report

I’m currently being moved over from DLA to PIP and I had my PIP medical (home visit) a week or so back (after waiting almost a year). I requested a copy of the ATOS assessor’s report by telephone, and received it in the post yesterday.

The report shows the points given to all of the descriptors in each category. I’ve been given less points than I believe I genuinely qualify for. Under DLA I receive middle rate care and higher rate mobility. If DWP accepts the ATOS report I will get standard rates for both which amounts to a big cut in my monthly benefit. And I’m in a worse state now, both physically and mentally, than I was back when I originally applied for DLA.

In the medical report, the assessor has been accurate is some ways, but has missed certain key things out, minimised the impact of some of my conditions on my daily life and has put a more positive gloss on my interview than I would have expected. His comments are one-liners.

It is terrible when you live in pain 24/7 under great duress that you are reduced to this, and have to go through even more stress to ‘justify’ your disability. I have to say I thought I’d given a pretty good account of how my disabilities affect me & didn’t find the interview too stressful despite it lasting two hours. I was at home (I would’ve found it impossible and extremely painful to travel any distance), I felt well-prepared (thanks to your excellent notes & forum advice) & I had a friend with me for moral support and to take notes. Also the assessor was polite and not intimidating, however I did get quite distressed in parts & clearly was in pain when I moved. I now feel very anxious about this report.

I’d be very grateful if you could answer these questions for me:

1 Should I write to complain to ATOS now, pointing out the things I feel should be put right, or should I wait for the DWP official letter to come through before I act & then start the process of mandatory reconsideration?

2 Am I right in thinking that in making their decision the DWP Case Manager will take into consideration both the ATOS medical report AND my original claim form (the latter is more detailed)? Or will they just read the ATOS report (brief)?

3 The ATOS medical report is suggesting a 4 year fixed award. I read somewhere online that if you’re over State Pension age and your PIP award is for a fixed period (as opposed to ongoing), it’s impossible to then get Enhanced Mobility at a later date when you get a review, even if your mobility has worsened. Is this true?

As ever, thanks very much for your advice, this is a wonderful site.

Dexy wrote: I’m currently being moved over from DLA to PIP and I had my PIP medical (home visit) a week or so back (after waiting almost a year). I requested a copy of the ATOS assessor’s report by telephone, and received it in the post yesterday.

The report shows the points given to all of the descriptors in each category. I’ve been given less points than I believe I genuinely qualify for. Under DLA I receive middle rate care and higher rate mobility. If DWP accepts the ATOS report I will get standard rates for both which amounts to a big cut in my monthly benefit. And I’m in a worse state now, both physically and mentally, than I was back when I originally applied for DLA.

In the medical report, the assessor has been accurate is some ways, but has missed certain key things out, minimised the impact of some of my conditions on my daily life and has put a more positive gloss on my interview than I would have expected. His comments are one-liners.

It is terrible when you live in pain 24/7 under great duress that you are reduced to this, and have to go through even more stress to ‘justify’ your disability. I have to say I thought I’d given a pretty good account of how my disabilities affect me & didn’t find the interview too stressful despite it lasting two hours. I was at home (I would’ve found it impossible and extremely painful to travel any distance), I felt well-prepared (thanks to your excellent notes & forum advice) & I had a friend with me for moral support and to take notes. Also the assessor was polite and not intimidating, however I did get quite distressed in parts & clearly was in pain when I moved. I now feel very anxious about this report.

I’d be very grateful if you could answer these questions for me:

1 Should I write to complain to ATOS now, pointing out the things I feel should be put right, or should I wait for the DWP official letter to come through before I act & then start the process of mandatory reconsideration?

2 Am I right in thinking that in making their decision the DWP Case Manager will take into consideration both the ATOS medical report AND my original claim form (the latter is more detailed)? Or will they just read the ATOS report (brief)?

3 The ATOS medical report is suggesting a 4 year fixed award. I read somewhere online that if you’re over State Pension age and your PIP award is for a fixed period (as opposed to ongoing), it’s impossible to then get Enhanced Mobility at a later date when you get a review, even if your mobility has worsened. Is this true?

As ever, thanks very much for your advice, this is a wonderful site.

Hi D,

Firstly I must state that the qualifying criteria fro DLA and PIP are very different.

Therefore, it does not follow that as you received a High Rate DLA Award, that you will receive an Enhanced Rate PIP Award.

e.g. The bench-mark distance for an Enhanced PIP Mobility Award is 20 metres for a HR DLA Award it was 50 metres.

A DLA HR Mobility Award could be made for being "Virtually Unable to Walk", there is no such criteria for PIP.

PIP is points based, DLA was not.

This is all covered in our : PIP Claims Guide. (2nd Link on page)

"1 Should I write to complain to ATOS now, pointing out the things I feel should be put right, or should I wait for the DWP official letter to come through before I act & then start the process of mandatory reconsideration?"

You could complain now to ATOS regarding the accuracy/quality of the Assessor's Medical Report, or you could wait until you receive a Decision from The DWP.

It is up to you !

However, any complaint to ATOS should be kept as a totally separate issue to any MR Request/Appeal if you receive an adverse decision.

As you may know, the PIP Case Manager does not have to abide by The ATOS Assessor's recommendations.

To complain cite PIP and your NI Number to :

This email address is being protected from spambots. You need JavaScript enabled to view it.

"2 Am I right in thinking that in making their decision the DWP Case Manager will take into consideration both the ATOS medical report AND my original claim form (the latter is more detailed)? Or will they just read the ATOS report (brief)?"

In coming to a decision The Case Manager is supposed to take "All" evidence that they have before them into account, not just the ATOS Assessor's recommendations.

They should then make a decision on the balance of probabilities.

Remember, DWP DM's (Case Managers) are not medically qualified.

"3 The ATOS medical report is suggesting a 4 year fixed award. I read somewhere online that if you’re over State Pension age and your PIP award is for a fixed period (as opposed to ongoing), it’s impossible to then get Enhanced Mobility at a later date when you get a review, even if your mobility has worsened. Is this true?"

If you are in receipt of a PIP or DLA Mobility Award before reaching 65, you can continue to receive the Mobility award after reaching 65, as long as you still qualify for it under the DLA/PIP qualifying criteria.

Someone that want to make a fresh claim after reaching 65, cannot claim DLA or PIP, they can only claim Attendance Allowance which only looks at Care Needs.

bro58

Thank you bro58 for your answer. Yes I understand the 20 metre rule, but thanks for making sure I do!

Could you please clarify something you said, which I don't quite understand?

"any complaint to ATOS should be kept as a totally separate issue to any MR Request/Appeal if you receive an adverse decision."

Are you saying that if I were to complain to ATOS first before receiving the official letter from DWP and if - on receiving the DWP letter - I decided to go for MR or Appeal, then I shouldn't mention that I have already complained to ATOS?

How will the DWP know that I have complained? Surely they would need to know one way or the other, as they base their decision partly on the content of the ATOS report?

Also with regard to the age limit question, my medical report states a fixed term of 4 years, when I will be 67.

Will I be invited to renew PIP at that point? If yes, would I be able to try for Enhanced Mobility at that point, even if I am only awarded Standard Mobility at the moment?

I get very confused, sorry.

Thanks for your help.

Dexy wrote: Thank you bro58 for your answer. Yes I understand the 20 metre rule, but thanks for making sure I do!

Could you please clarify something you said, which I don't quite understand?

"any complaint to ATOS should be kept as a totally separate issue to any MR Request/Appeal if you receive an adverse decision."

Are you saying that if I were to complain to ATOS first before receiving the official letter from DWP and if - on receiving the DWP letter - I decided to go for MR or Appeal, then I shouldn't mention that I have already complained to ATOS?

How will the DWP know that I have complained? Surely they would need to know one way or the other, as they base their decision partly on the content of the ATOS report?

Also with regard to the age limit question, my medical report states a fixed term of 4 years, when I will be 67.

Will I be invited to renew PIP at that point? If yes, would I be able to try for Enhanced Mobility at that point, even if I am only awarded Standard Mobility at the moment?

I get very confused, sorry.

Thanks for your help.

Hi D,

""any complaint to ATOS should be kept as a totally separate issue to any MR Request/Appeal if you receive an adverse decision."

Are you saying that if I were to complain to ATOS first before receiving the official letter from DWP and if - on receiving the DWP letter - I decided to go for MR or Appeal, then I shouldn't mention that I have already complained to ATOS?"

No, I am not saying that.

What I am saying is that any complaint to ATOS should be a separate issue to that of an MR/Appeal to The DWP.

The most that you can expect from a complaint to ATOS would be an apology, and maybe a fresh assessment.

ATOS cannot remake/revise an adverse PIP decision, only The DWP or a subsequent First Tier Tribunal, can do that

If you have to request an MR, it may help to point out any discrepancies within the medical report to the reviewing PIP Case Manager, but the important issue would be to clarify/reiterate how and why you should receive the appropriate amount of points for the relevant PIP Descriptor/s.

"Also with regard to the age limit question, my medical report states a fixed term of 4 years, when I will be 67."

In the case of a 4 year PIP award, you could expect to receive your review PIP Forms around a year before the end of the 4 year award, so that would be 3 years from the date of the PIP Decision.

As long as you still qualified for PIP at the same level or at an increased level, you would still receive a PIP Award as the result of a successful renewal/review of your PIP after 65.

All this is covered in our PIP Claims Guide.

bro58

Bro58 - Thank you for clarifying this. I understand now.

Personally, I would say if you are sure the medical professional has ignored/dismissed valid medical points that you have raised, then why not also complain to their professional regulatory body, the GMC for doctors, NMWC for nurses.
After all, they are held to account by them over and above ATOS and DWP.